Gluten: What’s the big deal?

February 6, 2017

As we approach yet another holiday known for its sweet treats we at Bambú would like to share with you one way to reduce the burden of those Valentine goodies. Whether you are intolerant to gluten or not, everyone can benefit from a little variety in their diet, and eating gluten-free is one way to diversify the grains you consume.

Don’t forget to stop by the clinic between 3 and 6pm on Wednesday, February 10th for a gluten-free showcase of sweet and savory treats – we’d love to see you!

Gluten: What’s the big deal?

Gluten is a protein found in wheat, barley, rye, and spelt. It’s never been easy for people to digest, but over the years wheat has become one of the easiest crops to mass produce and because of this our exposure to gluten has skyrocketed. This tiny protein makes its way into the average American diet many times a day, every single day. Unless a baked good is specifically labeled gluten-free, it was most likely made with wheat flour. Cereal, bread, bagels, pasta, crackers, cookies, cakes, pastries, flour tortillas all contain gluten. Unless we are consciously watching how much we consume, many Americans are eating gluten between 3 and 6 times a day! Any food eaten this often runs the risk of becoming problematic. The two most common gluten-related health concerns are celiac disease and gluten intolerance.

Celiac disease is an auto-immune condition that gets triggered by the ingestion of gluten. In celiac disease the body responds to gluten like a threat, and the same antibodies that attack the gluten in order to get rid of it actually attack the lining of the intestines as well. This assault on the digestive tract leads to extensive nutrient malabsorption and related disorders (anemia, osteoporosis, infertility and miscarriages just to name a few). Once thought of as a rare condition, the incidence of celiac disease is on the rise around the world, and affects at least 3 million people (1 in 133) in the United States alone. Because there is a genetic component to the disease, incidence among family members is increased to 1 in 22 people.

Gluten intolerance resembles celiac in that people who are intolerant also produce antibodies to gluten. These antibodies, however, do not attack the lining of the intestine. While they can create a great deal of inflammation and physical distress, they tend not to lead to the same amount of tissue destruction. Gluten intolerance can cause a wide range of symptoms, but is not an autoimmune condition. It’s estimated that as many as 30-40% of people may have some kind of reaction to gluten.

Symptoms for celiac and gluten intolerance often overlap. Potentially frustrating for patients and clinicians alike, the symptom pictures can vary so much from person to person that diagnosis can be challenging. People may not experience any abdominal symptoms at all – leading many physicians away from the idea that food may be a culprit. Celiac patients and gluten intolerant people alike may experience any of the following:

Bloating and gas

Abdominal pain

Indigestion and reflux

Chronic diarrhea

Chronic constipation

Vomiting

Fatty stool

Foul smelling stool

Weight gain

Weight loss

Failure to thrive in infants

Delayed growth and/or puberty in children

Unexplained iron-deficiency anemia

Fatigue

Bone or joint pain

Arthritis

Bone loss or osteoporosis

Depression or anxiety

Tingling numbness in the hands and feet

Seizures

Missed or irregular menstrual periods

Infertility or recurrent miscarriage

Canker sores inside the mouth

Rashes

Hair loss

In addition, many people with celiac disease have an increased incidence of other autoimmune conditions, including type 1 diabetes, Sjogren’s syndrome, rheumatoid arthritis, and autoimmune liver and thyroid disease. Left untreated, celiac disease increases the risk for liver complications and digestive tract cancers later in life.

There is some question as to whether gluten intolerance that is ignored can eventually become celiac disease. Are these two independent conditions or simply two ends of a spectrum for a single disorder? The jury is out on medical classification – but one thing is for sure, both conditions require treatment and care.

Diagnosis and Treatment: What to do?

Antibody levels are the first thing to check when concerned about a gluten reaction. Naturopaths often look at salivary or fecal IgA antibodies to gluten first, and if further work up is needed move along to blood draws. Kenneth Fine, MD, of Enterolab (a laboratory that specifically diagnoses food intolerances) believes that checking for reaction in the GI tract (saliva or stool) is a more accurate way of diagnosing intolerances than looking in the blood. First, look where the reaction is actually occurring. If a positive reaction is found in the gut, then look to the blood and see how extensive it is. Blood tests can look for both antibodies to gluten and antibodies that attack intestinal mucosa (for celiac disease). If the latter are positive the gold standard for celiac diagnosis is an intestinal biopsy.

The most important treatment in either condition is a gluten-free diet. We know that this can be challenging, and we also know that it’s become much, much easier to do over the past several years. With the number of people finding that gluten doesn’t agree with them, the number of substitute products, cookbooks, and resources on the market these days is astounding.

Other treatments help to reestablish gut mucosa health while replacing valuable nutrients lost from chronic malabsorption (iron, folate, vitamins D and B12 in particular). The GI tract is a microenvironment unto its own. Long-term inflammation from ongoing exposure to gluten can greatly compromise the function of the tract – what’s the quality of the saliva? How much stomach acid is produced? How well does the pancreas secrete digestive enzymes? What’s the balance of good gut bacteria? It’s important that treatment not stop with diet alone, but that people work with a trained clinician to help investigate these questions in order to restore optimal gut function.

Gluten-Free V-Day Recipe: Super Moist Brownies

Try out the following recipe on your family and friends, we promise they won’t know the difference! And if you have favorite recipes you’d like to share, email them to us. We’d love to post them on our website so others can benefit, too!

Preheat oven to 350°. Combine chocolate and butter over low heat until melted. Place chocolate into a mixing bowl and add sugar, eggs, and vanilla. Lightly beat by hand until combined. Stir in dry ingredients. Spread into an 8 x 8 inch greased baking pan and bake for 25-30 min at 350°. These brownies freeze well (if there are any left!) for a rainy day treat. Enjoy!

Thank you,

We hope you found this information helpful. We strive to help our patients find a healthy way in the world. If you have topics you’d like us to address in future issues please let us know. We are always available for questions and comments.